Citation Nr: 22019622 Decision Date: 04/02/22 Archive Date: 04/02/22 DOCKET NO. 15-00 730 DATE: April 2, 2022 ORDER Service connection for a neck condition, to include as secondary to a service-connected lumbar spine degenerative joint disease and spondylolisthesis (lumbar spine condition), is denied. FINDING OF FACT The evidence persuasively weighs against finding that the Veteran's neck condition had its onset during service, within one year thereafter, or is otherwise etiologically related to his active duty service, to include as secondary to his service-connected lumbar spine condition. CONCLUSION OF LAW The criteria for service connection for a neck condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Air Force from March 1974 to July 1995. In May 2018 and November 2021, the Board of Veterans' Appeals (Board) remanded this matter for additional development. In February 2017, the Veteran testified before a Veterans Law Judge (VLJ). The presiding VLJ has since retired from the Board. The Veteran was offered an additional hearing but did not respond. Accordingly, the Board will proceed to consider the evidence of record. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). There are three requirements to establish service connection: (1) the existence of a current disability; (2) the existence of the disease or injury in service; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be established on a secondary basis for a disability that is proximately due to, or the result of, a service-connected disability. See 38 C.F.R. § 3. 310(a). Secondary service connection may be established for a disorder that is caused or aggravated by a service-connected disability. Id. § 3.310(b); Allen v. Brown, 7 Vet. App. 439, 447-48 (1995). To establish secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 511 (1998); Allen, 7 Vet. App. at. 448. Although all of the evidence must be reviewed, only the most salient evidence must be discussed. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Persuasive or unpersuasive evidence must be identified, however, and reasons must be provided for rejecting favorable evidence. Gabrielson v. Brown, 7 Vet. App. 36 (1994), Wilson v. Derwinski, 2 Vet. App. 614 (1992). Both medical and lay or non-medical evidence may be discounted in light of its inherent characteristics and relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). When there is an approximate balance of positive and negative evidence, the claimant must be afforded the benefit of the doubt. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Entitlement to service connection for a neck condition. The Veteran seeks service connection for a neck condition, which he claims is due to a back injury sustained in service, or as secondary to his service-connected lumbar spine condition. The record establishes that the Veteran has a current diagnosis for a neck condition, and he is also service-connected for a lumbar spine condition. The Veteran's service treatment records (STRs) show that in December 1978, he slipped and fell, and landed on his back, which resulted in a back strain. An August 1987 entry reveals that the Veteran was undergoing physical therapy for his back. A treatment entry from September 1994 shows the Veteran was diagnosed with a lumbosacral strain after visiting clinicians with complaints of low back pain due to lifting a table. Notably, however, aside from complaints of low back pain, the STRs do not contain any complaints, diagnoses, or treatment for neck pain. For example, in an August 1994 periodic non-flying medical examination, completed within the year prior to the Veteran's separation from service, his head, face, neck, and scalp, and spine, other musculoskeletal systems were clinically evaluated as normal. See STRs received June 2013. The first documented complaints of neck pain come from a November 2002 private treatment record. Specifically, the Veteran complained of pain on the left side of his neck that radiated to his left upper extremity. See Private Treatment Record received June 2003. The Veteran also underwent a November 2002 MRI of his cervical spine, which showed severe cervical spine spondylosis. In March 2003, the Veteran sought treatment for complaints of neck pain. Specifically, the treatment note indicated that the Veteran had been experiencing increasing problems with neck pain for the prior three to four years. Additionally, it indicated the Veteran was experiencing problems with pain, numbness and tingling down his left arm and into the fingers of his left hand. See Private Treatment Record received March 2003. A December 2010 private treatment record indicated that the Veteran had begun experiencing low back pain in March 2010. See Private Treatment Record received January 2011. VA and private treatment records from March 2003 to the present show continued treatment for neck pain. Moreover, a private treatment record shows that in May 2015, the Veteran underwent neck surgery. See Private Treatment Record received May 2017. Notably, however, the VA and private treatment records do not contain an opinion addressing the etiology of the Veteran's current neck condition. In February 2017, the Veteran testified at a Board hearing. Regarding his neck condition, the Veteran reported undergoing surgery on his neck in May 2015. Additionally, the Veteran testified that in March or April 2010, he had an MRI performed on his back, and the physician who reviewed the imaging report told him he had more arthritis in his neck than anywhere else in his entire body. See February 2017 Hearing Transcript. In June 2021, the Veteran underwent a VA examination to evaluate the nature and etiology of his neck condition. The examiner diagnosed status post cervical spine fusion with bilateral upper extremity radiculopathy and rendered a negative nexus opinion. The examiner explained that she was unable to find medical records showing treatment for a neck injury while in service, and, therefore, it was less likely than not that the Veteran's neck condition was caused by service. Additionally, the examiner opined it was less likely than not that the Veteran's neck condition was proximately due to or a result of his service-connected lumbar spine condition. For rationale, the examiner indicated while the lumbar spine could begin to affect the thoracic spine, which was directly above it, the lumbar spine did not affect the cervical spine. The examiner explained there was no pathophysiologic relationship between the lumbar spine and cervical spine. Additionally, the examiner opined the Veteran's neck condition was not affected by his lumbar spine condition. In this regard, the examiner noted the Veteran began to experience neck pain prior to his lumbar spine condition in 2004. Moreover, the examiner indicated she was unable to establish the severity of his neck condition, as there was no mention of it in the medical records. See June 2021 VA Medical Opinion. Thereafter, in a November 2021 decision, the Board found the June 2021 VA medical opinion to be conclusory and remanded the matter in order to obtain a new VA medical opinion. The remand directive specifically requested that the VA examiner provide an opinion as to whether the Veteran's neck condition was incurred in or caused by service, or, alternatively, was caused or aggravated by his service-connected disabilities, to specifically include his service-connected lumbar spine degenerative joint disease and spondylolisthesis. See November 2021 Board Decision. Following the November 2021 remand, a December 2021 VA medical opinion was obtained to assess the etiology of the Veteran's neck condition. The examiner diagnosed degenerative disc disease other than intervertebral disc syndrome (IVDS) and rendered a negative nexus opinion. When addressing service connection on a direct basis, the examiner wrote that the Veteran's STRs showed no treatment, imaging, injury or diagnosis of record. She indicated that the outside treatment records supported the onset of neck symptoms around 1999 or 2000, and opined that the Veteran's current neck condition was more likely the normal result of aging and genetics and less likely than not incurred in or caused by service or an in-service event. Additionally, the examiner included an article from Johns Hopkins Medicine, which indicated that the joints of the spine wear out with age. Specifically, the article stated that one of the more unfortunate aspects of getting older was that the joints began to wear out, oftentimes for no good reason. The article indicated that the exact reason why the joints of the spine wore out was not known, and might be due to a combination of factors, such as lifting, having a family history of spine problems, or having an injury to the spine. The article ended by noting that, regardless of the cause, it was well known that arthritis of the spine often increased with increasing maturity for no reason that could be identified. Therefore, the examiner opined she was unable to establish a nexus to service and noted the record contained no treatment, imaging, injury, or diagnosis. When addressing secondary service connection, the examiner opined the Veteran's neck condition was less likely than not proximately due to or the result of a service-connected condition. For rationale, the examiner wrote that the medical literature did not support a theory that any of the Veteran's service-connected conditions caused or contributed to the development of his cervical degenerative disc disease with stenosis and radiculopathy. Additionally, the examiner included the same excerpt from Johns Hopkins Medicine, which indicated that the joints of the spine wore out with age, oftentimes for no good reason. Lastly, the examiner opined that the Veteran's current condition was more likely the normal result of aging and genetics. See December 2021 VA Medical Opinion. The Board finds the December 2021 VA medical opinion to be highly probative as it was based on a thorough review of the record and was supported by an adequate rationale and medical treatise evidence. There are no opinions, or other competent evidence, to the contrary. Based on the foregoing, the Board finds the evidence persuasively weighs against finding that the Veteran's neck condition manifested during active duty service, within one year of active duty service, or is otherwise related to service, to include as secondary to the Veteran's lumbar spine condition. As the evidence persuasively weighs against the claim, the benefit of the doubt doctrine does not apply. See Lynch 21 F.4th at 776. Accordingly, the Veteran's claim for service connection for a neck condition is denied. (Continued on the next page) In reaching the above determination, the Board acknowledges that the Veteran may believe his neck condition is related to service or to his service-connected lumbar spine condition. Nevertheless, while the Veteran is competent as a layperson to testify to observable symptoms that he experiences, he does not have the medical training or credentials to provide a competent opinion as to the diagnosis or etiology of his neck condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Board finds these contentions to be entitled little to no probative value are outweighed by the more probative evidence of record. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Talton, John H. The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.